Antidepressants/antimanics

Question 1

catecholamine hypothesis of depression

Answer 1

depleted 5HT/NE –> depression

Question 2

limitations of catecholamine hypothesis

Answer 2

immediate onset of drug action, but mood elevating effects take 2-3 weeks; minimal evidence to support theory

Question 3

neurodegenerative hypothesis of depression

Answer 3

prodepressive pathway: stress –> HPA axis activation –> gene expression –> neural apoptosis, enhanced glu-NMDA excitotoxicity

Question 4

antidepressive pathways

Answer 4

NE and 5HT –> GPCR –> gene expression –> neurogenesis, protection against apoptosis

BDNF –> TrkB –> gene expression –> neurogenesis, protection against apoptosis

Question 5

mechanism of TCADs

Answer 5

NE and/or 5HT reuptake inhibitor

Question 6

TCAD drugs

Answer 6

amitriptyline, imipramine, desipramine

Question 7

TCAD side effects

Answer 7

sedation, antimuscarinic, orthostatic hypotension, EKG abnormalities, tremor, weight gain, sexual dysfunction

Question 8

SSRI mechanism

Answer 8

selective serotonin reuptake inhibitors

Question 9

SSRI drugs

Answer 9

fluoxetine, paroxetine, sertraline

Question 10

SSRI side effects

Answer 10

acute: nausea, diarrhea, insomnia, restlessness, dry mouth
delayed: weight gain, sexual dysfunction, cognitive blunting

Question 11

bupropion mechanism

Answer 11

norepinephrine and dopamine reuptake inhibitor

Question 12

bupoprion side effects

Answer 12

dizziness, dry mouth, tremor, insomnia, anxiety, aggravated psychosis, seizures at high doses

Question 13

venlafaxine mechanism

Answer 13

serotonin and norepiephrine reuptake inhibitors

Question 14

venlafaxine side effects

Answer 14

hypertension, anxiety, nausea, somnolence, sweating, dizziness, sexual dysfunction

Question 15

trazodone mechanism

Answer 15

mixed postsynaptic antagonist-serotonin reuptake inhibitor

Question 16

MAOIs (phenelzine) side effects

Answer 16

postural hypertension, seizures, shock, hyperthermia in overdose

Question 17

ECT mechanism

Answer 17

increased activity and amount of tyrosine hydroxylase (norepinephrine) and tryptophan hydroxylase (serotonin) –> increased neurotransmitter levels

Question 18

Lithium mechanism

Answer 18

may enhance serotonin action and/or NE and DA effect (interferes with Gq signaling)

Question 19

Lithium use

Answer 19

prevention of both manic and depressive episodes

Question 20

Lithium side effects

Answer 20

fine tremor, GI effects, muscle weakness, decreased thyroid function, polyuria, polydipsia

Question 21

Lithium DDIs

Answer 21

diuretics –> decreased renal clearance –> increased Li plasma levels

NSAIDs –> increased Li plasma levels

Question 22

Valproic acid mechanism

Answer 22

block VSSC –> stabilized and reduced propogation of excessive nerve impulses

Question 23

Valproic acid use

Answer 23

bipolar mania

Question 24

Common drug interactions

Answer 24

most antidepressive agents –> additive CNS depressant effects when used with other sedatives

Question 25

MAOI DDIs

Answer 25

hypertensive crisis with meperidine, decongestants, foods high in tyramine (beer, wine, cheese)

Question 26

SSRI + MAOi interaction

Answer 26

serotonin syndrome (hyperthermia, muscle rigidity, myclonus, rapid changes in mental status)

Question 27

Treatment of bipolar mania

Answer 27

all atypical antipsychotics, Li, valproic acid, carbamazepine

Question 28

treatment of bipolar depression

Answer 28

olanzapine+fluoxetine, quetiapine

Question 29

Maintenance therapy for bipolar disorder

Answer 29

Li, lamotrigine, aripiprazole, olanzapine

Question 30

bipolar relapse prevention

Answer 30

Li, olanzapine